02-103762 CITY Of /*-- • CONSTRILITION PERMIT APPLICATION
VVL
ElYRECEIVED APPLICATION NUMBER: 02- �' �
APPLICATION NUMBER: - -
SEP 0 42002 APPLICATION NUMBER: -
**The following is required information—Please print(in ink)or type**
Please note: ElectricaWild MWAYs and Engineering permits may require a separate application.
••• . u■t PROPERTY INFORMATION
41-
SITE ADDRESS: 3 6 3 / r U SSESSOR'S\7tTAX/PARCEL #: 2 2 v- az O
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
■ PROTECT INFORMATION-.
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): 4.£ d12 ' , frog
2- 4 ifca i
C, .0,-*, L i t
„PROJECT NAME:
• PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
)
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
CONTRACTOR: NAME: DAYTIME PHONE:
/761 AV1 G
IpkI4jN 0,p (STREETA CITY,STATE,ZIP): /1...4:001,0". EVENING PHONE:2,.„ ,
/
CITY OF FEDERAL,'SBUSINESS LI/S MBE Y9 ) -FAX NUMBER:)
l
CONTRACTOR'S REGISTRATION NUMBER: _b/'� EXPIRATION DATE:
(copy of card required) 64' 7 J _ ,/ P 0-° 3 //1
APPLICANT: NAME: y /DAYTIME PHONE:
MAILING /Di&4 A /4 )
MAILING DDRESS(STREET ADDRESS;CM,STATE,Z ): EVENING PHONE:
)l
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT El TENANT ❑ OTHER(DESCRIBE): ( )
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ,'CONTRACTOR
■ DETAILED BUILDING INFORMATION •
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑.LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ** •
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROSECT FLOOR AREAS •
FLOOR EXISTING SQ.FT. PROPOSED SQ. FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
...�..: s•ue+� ...-..a.•r.�' :+.w« r�:sNoa3:oivs!tta4•+iCr:vswhibatiir� �•iA�VRE�7x:'rai.*+v+asYst!}i.i.:.w...rF:.ss?.iu#•r.iMb?s�!cR1¢+?tiflaWsT �a:.,a+�.�akr:�.w!6t'.i;i:..
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( �)
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) Z- LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) 2— WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
•■'DISCLAIMER/SIGNATURE BLOCK •
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge,and
further,that I am authorized by the owner of the above premises to perform the work for which the permit application is made. I
further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred in the
investigation and defense of such daim),which may be made by any person,including the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the city,including its officers and employees,upon the accuracy
of the information supplied� to the dty aassa
�' a part of this application.
NAME/TITLE: 3 / �/`7`f' ,-/ DATE: � V °3
❑ PROPERTY OWNER ❑ APPLICANT )CONTRACTOR
_FOR OFFICE USE ONLY
NE1 =r❑_ADDITION ❑"ALTERATION x❑ REPAIR TENANT IMPROVEMENT ._.-;
CENSUSCODE =LOT,SIZE _
$ZONING DESIGNATION_,_ ,_ BUILDING SHELL ONLY?, ❑YES -_LINO
COMP`p AN DESIGNATION 4 r_BASXC PLAN'" `z❑ fES 1,C:0 NO .� rr
zSECTION ' •
TOWNSHIP ' RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO
r?'1TT DD LOT?.'; ❑YES ❑ No CHANGE OF USE? y'.,❑YES =CI NO „
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.cityoffedera Iway.com